ABSTRACT
It is well known that velopharyngeal insufficiency (VPI) is a potential risk following UPPP. The risk of VPI may be even greater in patients who undergo MMA after UPPP since the forward movement of the maxilla increases the anterior-posterior dimension of the velopharynx, and thus further compromises the velopharyngeal closure. Interestingly, we have found that despite the combined effect of UPPP and maxillary advancement on the velopharynx, the risk of VPI is low, in that less than 10% of the patients had very mild symptoms of VPI (41). The low incidence of VPI could also be due to the inherently narrowed pharyngeal airway, and the increased collapsibility of the pharyngeal tissues and soft palate that are usually found in OSA patients. The anatomic and physiologic characteristics that predispose these patients to the development of OSAS might have provided some ‘‘protective effect’’ on the development of VPI after MMA. However, it must be emphasized that the risk of VPI is a potential complication in these patients. Therefore, preoperative consultation regarding the possibility of VPI should be considered, especially in patients with excessively foreshortened soft palates due to aggressive UPPP, when there are preexisting VPI symptoms.
